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Elevance Health

Sells health insurance and pharmacy benefits

Nurse Case Manager 2

Medical, Clinical & VeterinaryPosted on Nov 11
Full-time

About the Job

Requirements

  • A bachelor's degree in a health-related field and at least five years of clinical experience, or an equivalent combination of education and experience.
  • A current, unrestricted registered nurse license in the applicable state or states.
  • Multi-state licensure is required if providing services in multiple states.

Responsibilities

  • Perform care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum.
  • Conduct assessments to identify individual needs and develop a specific care management plan with objectives and goals.
  • Facilitate authorizations and referrals within the benefits structure or through extra-contractual arrangements to implement care plans.
  • Coordinate internal and external resources to meet identified needs.
  • Monitor and evaluate care-plan effectiveness and modify plans as necessary.
  • Interface with Medical Directors and Physician Advisors on the development of care management treatment plans.
  • Negotiate reimbursement rates, as applicable.
  • Assist with problem solving involving providers, claims, or service issues.
  • Assist with the development of utilization and care management policies and procedures.
  • Perform duties telephonically or on-site, including hospital discharge planning.

Desired Qualifications

  • Certification as a Case Manager is preferred.
  • A bachelor's degree in a health or human-services-related field is preferred.

About the Company

Elevance Health

Sells health insurance and pharmacy benefits

Elevance Health is one of the largest U.S. health insurers, covering people through employers, individual plans, Medicare and Medicaid. It is the Blue Cross Blue Shield licensee in 14 states, where it sells plans under the Anthem name, and it runs government plans under the Wellpoint name in other markets. Its Carelon division runs the CarelonRx pharmacy benefit manager and sells behavioral health, care management and other services to its own plans and outside clients. Elevance earns most of its revenue from premiums paid by employers, members and government programs, plus fees for Carelon services. The company is headquartered in Indianapolis, Indiana.

Company size
10,001+
Company stage
IPO
Headquarters
Indianapolis, IN
Founded
1944

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